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目的:探讨小剂量咪达唑仑或氯胺酮预防七氟烷致非住院患儿术后躁动的有效性与安全性。方法:采用前瞻性随机对照研究方法,将在七氟烷全身麻醉下行斜视矫正术的患儿用抽签法随机分为咪达唑仑组、氯胺酮组和对照组。所有患儿均经面罩吸入8%七氟烷和氧气(5L/min)诱导麻醉,患儿意识消失、下颌松弛后置入喉罩,保留自主呼吸。吸入2.0%～2.5%七氟烷-N_2O-O_2维持麻醉。手术结束前10min,对照组、咪达唑仑组和氯胺酮组患儿分别经静脉缓慢推注0.9%氯化钠注射液5ml、咪达唑仑0.02mg/kg(用0.9%氯化钠注射液稀释至5ml)和氯胺酮0.2mg/kg(用0.9%氯化钠注射液稀释至5ml)。术毕拔除喉罩,将患儿送入麻醉后恢复室并进行躁动评分,若躁动评分≥4分则静脉推注丙泊酚2.0mg/kg。记录3组患儿麻醉时间、苏醒时间、术后躁动情况、是否使用丙泊酚、留院观察时间和不良反应的发生情况。结果:2010年5月至11月共61例患儿纳入试验。患儿年龄3～6岁,美国麻醉医师协会分级(ASA)Ⅰ～Ⅱ级。对照组男11例,女9例,平均年龄(5.0±0.8)岁,体重14～27kg;咪达唑仑组男13例,女8例,平均年龄(5.0±0.4)岁,体重13～24kg;氯胺酮组男10例,女10例,平均年龄(5.0±0.9)岁,体重15～30kg。3组患儿的性别、年龄、体重、单/双眼手术比等差异均无统计学意义(P>0.05)。咪达唑仑组与氯胺酮组患儿的苏醒时间[(32.8±6.5)、(28.6±8.6)min]明显长于对照组[(19.8±5.0)min,P<0.01],术后躁动发生率[19%(4/21)、15%(3/20)]明显低于对照组[55%(11/20),P<0.05]。3组患儿的麻醉时间、丙泊酚使用情况、留PACU观察时间、恶心呕吐发生情况等差异均无统计学意义。结论:小剂量咪达唑仑或氯胺酮均能安全有效地预防七氟烷吸入所致的患儿术后躁动。
Objective: To investigate the efficacy and safety of low-dose midazolam or ketamine in preventing post-operative agitation induced by sevoflurane in children. Methods: A prospective randomized controlled study was conducted in children undergoing general anesthesia for strabismus with strabismus. The children were randomized to midazolam, ketamine and control groups by random sampling. All children were anesthetized with inhalation of 8% sevoflurane and oxygen (5L / min) through the mask, the consciousness of children disappeared, and the larynx was loosened and placed into laryngeal mask to keep spontaneous breathing. Inhalation 2.0% ~ 2.5% Sevoflurane - N_2O-O_2 to maintain anesthesia. Ten minutes before the end of surgery, children in the control group, midazolam group and ketamine group were infused with 5 ml of 0.9% sodium chloride injection and 0.02 mg / kg of midazolam (0.9% sodium chloride injection Diluted to 5 ml) and ketamine 0.2 mg / kg (diluted to 5 ml with 0.9% sodium chloride injection). Surgery complete removal of laryngeal mask, the child into the recovery room after anesthesia and agitation score, if the agitation score ≥ 4 points, intravenous propofol 2.0mg / kg. The anesthesia time, recovery time, postoperative agitation, propofol use, time of hospital stay and incidence of adverse reactions were recorded in 3 groups. Results: From May to November 2010, a total of 61 children were included in the trial. Children aged 3 to 6 years old, American Society of Anesthesiologists classification (ASA) Ⅰ ~ Ⅱ grade. Control group, 11 males and 9 females, average age (5.0 ± 0.8) years old, body weight 14 ~ 27kg; Midazolam group 13 males and 8 females, average age (5.0 ± 0.4) years old, body weight 13 ~ 24kg ; Ketamine group of 10 males and 10 females, mean age (5.0 ± 0.9) years old, body weight 15 ~ 30kg. There was no significant difference in gender, age, weight, single / binocular surgery ratio between the three groups (P> 0.05). The awake time of midazolam group and ketamine group [(32.8 ± 6.5), (28.6 ± 8.6) min] was significantly longer than that of control group [(19.8 ± 5.0) min, P <0.01] 19% (4/21), 15% (3/20)] was significantly lower than the control group [55% (11/20), P <0.05]. The anesthesia time, the use of propofol, the duration of PACU stay, the incidence of nausea and vomiting in the three groups were not statistically significant. CONCLUSIONS: Low-dose midazolam or ketamine can both safely and effectively prevent postoperative agitation in children with sevoflurane inhalation.